Ethics of uncertainty

Uncertainty is inherent in clinical medicine. However, just because absolute certainty is unachievable does not mean that rational and optimal decisions cannot be made. It is argued that we need to distinguish legitimate from illegitimate scientific uncertainties that are generated by manufacturing doubts aiming to create mis- and disinformation. The attempt to create doubts implies that actions under uncertainties are impossible. Such a belief ultimately harms public, which requires reasoned actions within a context of genuine scientific and medical uncertainties. The latter indicates that rational decisions, even in the absence of guaranteed absolute certainty, are not only possible but, on average, beneficial both for society and individuals.     

针灸防治癌因性疲乏临床实践指南研究

目的:探索针灸防治癌因性疲乏的临床应用方案,为制定临床实践指南提供依据.方法:通过计算机检索国家知识基础设施数据库(CNKI)、中国学术期刊数据库(CSPD)、中文科技期刊数据库(CCD)、中国生物文献、PubMed、EMBASE、Cochrane Library等数据库,全面收集针灸疗法治疗癌因性疲乏的现代文献证据;...     

Evidence-based data and rare cancers: The need for a new methodological approach in research and investigation

Rare cancers are not so rare, their incidence is increasing and, as a group, they have worse survival than the common cancers. These factors emphasise the societal need to ensure sufficient focus on research into their biological basis, aetiological factors, new more effective therapies and organisation of healthcare to improve access to best practice and innovation. Accuracy of diagnosis is one of the first hurdles to be overcome, with around one third of tumours being reclassified – by type or risk group – when subject to a centralised pathology review process. Timely access to appropriate expert knowledge is a second challenge for patients – in Europe this is being addressed by the establishment of European Reference Networks (ERNs) as part of the EU cross border healthcare initiative. There are ERNs for adult solid and haematological cancers and childhood cancers, all of which are individually rare. These ERNs will facilitate creation of large databases of rare tumours that will incorporate knowledge of their molecular features and build an evidence base for the effectiveness of innovative, biology-directed therapies. With an increasing focus on ‘real world’ outcome data, research methodologies are evolving, to include randomised registry trials and data linkage approaches that exploit the ever-richer information held on patients in routine health care data. The inclusion of genomic analysis into cancer diagnosis, treatment and risk prediction raises many issues for the conduct of clinical research and cohort studies and personal data sharing. Sophisticated means of pseudonymisation, together with full involvement of affected and ‘at risk’ patients, are supporting novel research designs and access to data that will continue to build the evidence base to improve outcomes for patients with rare cancers.     

正确理解“精准医学”在临床实践中的意义

2015年初在美国正式提出一个在研究基因序列的基础上,探索疾病的根源,预防和治疗的规划并被定名为Precision medicine,译称"精确医学"或"精准医学"。该定义在临床医生中引起了不同的意见和疑虑,因为这涉及到临床医学研究和实践中的导向问题。精准医学应该是对医学服务的一种要求,要求医学服务从行为和方法上达到精准,以基因序列和表达调控为基础的分子医学是狭义的精准医学,与临床医学所要求的精准相互关联又有所不同。临床工作者直接面对大多数病人,须要运用符合现代医学认可的各种各样的方法(包括基因系列的成果)解决病人的问题,而不管这种方法是否基于基因分析的结果。这种以循证医学为基础的临床医学属广义的精准医学。     

The Enlightenment of Evidence and the Leap in the Dark

This article is a free inspiration following R.D. Hinshelwood's ‘Intuition from beginning to end?’. The author tries to show Bion's Kleinian skill to listen to every detail of the clinical hour, picking up clues and putting them together to render meanings and presenting them to the patient. While doing so, Bion created a richness of concepts for analysts to try out as tools for observation and understanding of their patients’ mental functioning. Several of these concepts along with the clinical inspirations are described here. The author believes, therefore, that even during his ‘loyalty to Klein’ period, Bion was also extremely creative though inspired by Klein. When it comes to intuition, the author prefers to be modest, listen to the patient's free associations and allow intuitions to mate with concepts before getting back to the patient.